Two Lists

Another resident said something last night that got me thinking.

Something to the effect of, "I was just saying to this other resident, I wish I could be more like you [meaning me].  You know, not so crazed all the time, staying super-late, agonizing over every decision..."

He meant it as an insult.  He means everything as an insult.  I don't necessarily dispute the characterization, but I definitely dispute the intent behind it.

I think there's an unfortunate tendency to assume that difficult people are better residents.  That someone might be a jerk, but they're a jerk on behalf of their patients, they're a jerk because they don't want to risk mistakes, they can't deal with anything less that perfection, they have high standards that they're simply demanding that everyone else live up to.

I don't want to say that no one falls into that category, but sometimes people are jerks because they're jerks, and it has nothing to do with how much medicine they know, or how much they do or don't care about their patients.  It's an entirely independent characteristic.

Of course the list of residents I like is to some extent different from the list of residents I'd send a family member to see.  There's a difference between being a good colleague and a good doctor.  Everyone wants to work with pleasant, efficient, friendly people.  But pleasant, efficient, and friendly don't necessarily have anything to do with diagnostic skills.  Sure, they has to do with bedside manner and patient relationships, and those are important.  But medical knowledge is entirely independent of tolerable personality.

The problem is that it doesn't make any more sense for me to say that all the jerks are good doctors than it does for me to say that all the people I'd want to play softball with are good doctors.  The truth is, I don't know how good most people are, unless I've worked with them-- and even if I've worked with them, people are good at some things, and not so good at others.  Some patients get better-- and some don't, no matter what you do.

Looking busy-- looking stressed, staying late, taking hours to write a note that should take minutes, double-checking orders you know you put in, waking patients up just to make sure they wake up, running tests just to run tests and give you a reason to still be there at midnight-- does not necessarily make someone a better doctor.  At the same time, writing notes as fast as you can, double-checking nothing, and failing to notice patients who haven't woken up in quite some time-- not so good either.  

The point?  I don't know...